PFAS: Understanding the Risks and the Role of Testing

TRANSCRIPT for Podcast Episode with the title PFAS: Understanding the Risks and the Role of Testing

Voiceover [00:00:02]: Welcome to the Results are In from Quest.

Voiceover [00:00:04]: Diagnostics, conversations with diagnostics industry leaders who.

Voiceover [00:00:08]: Enable optimized care pathways for patients.

Dr. Jack Kain [00:00:14]:

Welcome to another episode of the Results Are in from Quest Diagnostics. I'm your host today, Dr. Jack Kain, Director and Medical Science Liaison for Drug Monitoring and Environmental Toxicology at Quest Diagnostics. Today we're diving into an interesting topic that's making headlines across public health and environmental science. It's one I talk about probably every day with our guest, Dr. Bartock, who I'll introduce in a second. But that topic is PFAS or as you may have heard it, forever chemicals. So these man-made compounds have been detected in everything from drinking water to consumer goods and the potential health risks may be significant.

Dr. Jack Kain [00:00:52]:

So in this episode we'll break down what PFAS are, where they're found, the potential of health concerns tied to exposure, and how blood testing can help patients and clinicians better understand and manage risk. We'll also discuss Quest's PFAS 9 panel test and what providers should know when interpreting results. As I know that that can be a little complex at times. So joining me to help shed some light on this very important topic is my colleague, Dr. Sarah Bartock, National Science Director of Drug Monitoring and Toxicology at Quest. Sarah, say hello. It is a pleasure to have you.

Sarah Bartock [00:01:29]:

Hi Jack, thanks for having me on the show.

Dr. Jack Kain [00:01:33]:

So let's start with the basics for those who may not be familiar with PFAS. What is pfas, what are they and why are they called forever chemicals?

Sarah Bartock [00:01:43]:

Sure. Yeah. PFAS are per and polyfluoroalkyl substances. They're a class of man-made chemicals that have been used in industry and consumer products for several decades. They're known as forever chemicals because they don't naturally break down.

Dr. Jack Kain [00:01:58]:

So how widespread is PFAS exposure in.

Sarah Bartock [00:02:00]:

The US because of their ubiquitous use, PFAS have been found to contaminate everything around us, water, food, soil and air. And various studies and reports have found PFAS in 45% of US tap water contaminating drinking water for more than 200 million Americans. Additionally, one report reviewed by the CDC using data from the National Health and Nutrition Examination Survey or NHANES found that PFAS in the blood of 97% of Americans.

Dr. Jack Kain [00:02:28]:

And what are some common sources people might not even realize they're coming into contact with?

Sarah Bartock [00:02:33]:

In addition to drinking water, PFAS are found in nonstick cookware, water resistant clothing, stain resistant fabrics and carpets, some cosmetics and industrial agents like firefighting foams.

Dr. Jack Kain [00:02:46]:

Wow. And we've seen studies showing, like, PFAS in drinking water, consumer goods, and even occupational settings. But who's most at risk for higher levels of exposure? You said those in known contaminated sites. Anywhere else?

Sarah Bartock [00:03:02]:

Yeah. So the people who are most at risk for higher levels of exposure are going to be people who have been exposed on the job, such as firefighters, people who use a water supply near a commercial or industrial location, people who live near a facility that manufactures fluorochemicals, and people who live near areas of documented environmental contamination. There's also a lot of work focused on children having higher PFAS exposure through ingestion, in particular over the adults.

Dr. Jack Kain [00:03:33]:

You know, and while high exposures, such as work exposure or contaminated environmental exposures, are of the highest risk for association with medical risk, it should be noted that low exposures and their risks are not fully understood at this time. So, you know, listeners should just keep that in mind. Low exposure, chronic. Low exposure, Chronic exposure at low levels, not fully understood at this time. So. But, you know, I know that we're watching it, and various organizations are as well. So, Sarah, can you walk us through the health concerns linked to PFAS exposure? Like, what conditions, when we talk about medical risk, and what conditions are clinicians keeping an eye on?

Sarah Bartock [00:04:14]:

Yeah. So while the science around the impacts of PFAS exposure is still emerging and evidence suggests that high PFAS exposure is associated with certain health conditions. So according to NASEM, there is a suggested association between PFAS exposure and a couple of the following health conditions, among other problems. So that would be decreased immune system response, higher than normal lipid levels or dyslipidemia, decreased growth in unborn babies and infants, and increased risk of kidney cancer in adults.

Dr. Jack Kain [00:04:45]:

Yeah, and testing can be an important tool for understanding the blood levels of PFAS. There's several chemicals, you know, the nine panel, we look at nine PFAS. But can you explain, like, how PFAS blood testing works? I know that you actually helped us develop the methods for it. We got it validated here at Quest. But tell us how it works and what it can reveal for patients and providers.

Sarah Bartock [00:05:07]:

A PFAS blood test measures the levels of certain PFAS chemicals in a patient's blood at the time of the test. Blood testing can help patients and clinicians monitor PFAS levels and assess whether there may have been any potential health risks associated with high exposure. The blood test also provides insights to support conversations around risk factors associated with these health outcomes, as well as ways to reduce patients PFAS exposure and monitor their health.

Dr. Jack Kain [00:05:36]:

Thank you, Sarah. And what is Quest offering in this space? And what does the PFAS 9 panel measure specifically? I know sometimes we joke that it kind of sounds like alphabet soup, but something our listeners can understand. What would that be?

Sarah Bartock [00:05:51]:

Sure. Quest Diagnostics offers a test for PFAS and that is the PFAS Forever Chemicals 9 panel. It measures the level of nine PFAS chemicals associated with certain health risks per NASEM recommendations providing the overall level and each of the nine PFAS individual levels. The results indicate how much PFAS has entered a patient's body over time. For patients with elevated PFAS, Quest also offers follow up testing to assess dyslipidemia, thyroid function, and kidney disease.

Dr. Jack Kain [00:06:21]:

And once a patient's results actually come back, what are the critical thresholds clinicians should be aware of? To me, like 20 is a number. Like 20 nanograms per milliliter is a number that stands out. So, what does that mean?

Sarah Bartock [00:06:36]:

Like in clinical practice? When NASEM recommended the nine panel PFAS summation, when that summation is between 2 and 20 nanogram per mL, clinicians and patients should look at ways to reduce exposure. That's what we should always be looking at. And also screen for dyslipidemia, hypertension disorders and pregnancy, and breast cancer. That again is for your values between 2 and 20. When the NASEM summation is greater than 20, the same guidance I just described should be followed as well as additional screening for more conditions. So again, clinicians and patients should always look at ways to reduce exposure. You're going to be screening for dyslipidemia, hypertension disorders in pregnancy, breast cancer. And at this elevated level, the NASAM guidelines layer in screening for thyroid function, signs and symptoms of kidney cancer, including urinalysis, signs and symptoms of testicular cancer and ulcerative colitis.

Sarah Bartock [00:07:34]:

And reducing exposure can start with simply just checking your zip code for contaminated public drinking water. The EPA has a PFAS map and you can type in your zip code and check at least your public drinking water. It's not going to capture all of the private wells. And we're advising folks to avoid nonstick cookware, stain resistant fabrics and fast food packaging, as well as using NSF certified water filters. So this is going to be your activated carbon or reverse osmosis. So that's what this test is going to facilitate is that conversation about reducing exposure.

Dr. Jack Kain [00:08:08]:

Yeah. Personally I drink reverse osmosis water myself just because of what we know now about PFAS. But you know, there's clinical benefits to testing. And as you can imagine, there's going to be limitations to testing for PFAS exposure. What are some of those limitations?

Sarah Bartock [00:08:26]:

A PFAS blood test cannot tell you where the PFAS in the patient's body came from. So it can't tell you the source. It also can't tell you how long a patient has been exposed to PFAS. The blood test cannot tell you whether any health condition was directly caused by PFAS. And it cannot tell you whether a person is likely to develop certain health problems in the future.

Dr. Jack Kain [00:08:50]:

And if a patient's levels are elevated, are there strategies to reduce exposure or monitor long-term risk?

Sarah Bartock [00:08:57]:

Yeah, Jack, so this is a really exciting area. There's a lot of emerging intervention research that's coming out that's supporting ways to eliminate PFAS from your body. Before I discuss these options, I just want to state that these are potential therapeutic alternatives. They have not yet been approved by the FDA for PFAS removal from your body. And the decisions should be absolutely personalized because research is still ongoing in this area. But there's really four main exciting areas of emerging interventions. Studies by Møller et al in 2024 and Ducatman et al show that bile acid sequestrants like cholestyramine may clear PFAS from the body quicker than half-life of these compounds. This treatment may be a great way for patients with very high levels to reduce the body burden after the source of exposure has been identified and eliminated.

Sarah Bartock [00:09:49]:

Lindell et al in 2025 demonstrated that certain probiotics can promote PFAS elimination from the body. So that's another exciting one.

Dr. Jack Kain [00:09:58]:

Wow.

Sarah Bartock [00:09:58]:

And then finally, fiber supplementation and folate supplementation were the focus of a few recent studies published 2021 to2025. And these studies show that these interventions also help reduce PFAS in the body.

Dr. Jack Kain [00:10:12]:

So it's good to know. Look, it's not, it's not completely hopeless out there. There's a ton of research going into finding therapeutic modalities for reducing PFAS body burden. And it's really encouraging to hear you outline some of these emerging findings and therapeutic interventions that are on the horizon. So we will definitely be keeping an eye on that. And I think it gives the. It increasingly gives our test clinical utility. But what are some of the challenges around the PFAS pervasiveness in the environment and what causes that pervasiveness?

Sarah Bartock [00:10:50]:

Yeah. So Jack, some industries are still struggling to phase PFAS out. Removing PFAS from the environment is just really challenging, especially from water because they can slip through many filtration systems. According to one reference in 2023, significant capital estimated at 4,400 billion dollars is really needed to clean up and protect our US drinking water with new filtration systems costing millions more annually to operate. And so the chemical nature of PFAS is really what makes them particularly pervasive. They're just resistant to degradation in the environment, they're incredibly durable, they have long half lives. And there have been some changes in the industry to swap out the really pervasive chemicals for less pervasive shorter chain compounds. But we're still learning about these alternatives and what the impacts for those on health conditions are.

Dr. Jack Kain [00:11:43]:

Okay, and how do you see PFAS fitting into the preventive care model and patient conversations moving forward? Like is this something we should expect to become more routine?

Sarah Bartock [00:11:54]:

In deciding whether to order PFAS testing, we advise clinicians and patients to consider a few things. The patient's exposure history, results of the PFAS testing from the patient's water supply or food sources or other exposure routes if you've personally sent out for that kind of water testing or again based on that EPA map and also whether the results can inform exposure reduction and health promotion. Right now, PFAS testing is not routine. But at Quest, we're actively engaged with our research partners and our functional integrative clinicians who are working on strengthening that evidence between PFAS and health associations and really dipping into that preventative area with those emerging interventions, you know, identifying this exposure early and eliminating your levels, decreasing them drastically to prevent possible health conditions later. That's what we're really excited about and engaged with our research partners.

Dr. Jack Kain [00:12:52]:

Thank you Sarah. And finally, like if clinicians or patients want to learn more about ordering testing, where can they find additional resources at Quest Diagnostics

Sarah Bartock [00:13:01]:

For clinicians and patients? Our Quest Diagnostic website, our test directory has all this information. I've just gone over simply searching for PFAS or Forever Chemicals in our test directory is going to direct you to the physician-based test to order as well as a test summary and an FAQ we have we also have consumer testing available on questhealth.com anyone can order this test. So I encourage you to check out the information on questhealth.com. We also have a dedicated inbox that we're monitoring for all types of inquiries around this testing. Questions around larger panels, do we offer additional analytes. I'm interested in setting up a study with you. I'm interested in doing testing for anyone in my household and so that email box is going to be PFAStesting@QuestDiagnostics.com so those are just some of the ways to get a hold of us.

Dr. Jack Kain [00:13:50]:

Jack and that was PFAStesting@QuestDiagnostics.com right?

Sarah Bartock [00:13:55]:

Correct. PFAStesting@QuestDiagnostics.com perfect.

Dr. Jack Kain [00:14:00]:

So that brings us to the end of today's episode. I'd like to extend a huge thank you to Dr. Sarah Bartok for sharing her insights on the growing issue of PFAS exposure and the role of testing in patient care. I know we talk about it every day here at Quest Diagnostics, but you know, we learned what PFAS are, the health impacts they may pose, and how testing can empower both providers and patients to make informed decisions. Quest Diagnostics is committed to providing tools like the PFAS 9 panel to support these efforts. If you enjoyed this conversation and want to stay up to date about the latest advancements and blood based diagnostic testing, please make sure to subscribe to the show and leave a review you won't want to miss our upcoming episodes where we dive into more groundbreaking research and real-world stories that impact patient care. Thanks for tuning in. I'm Dr.

Dr. Jack Kain [00:14:52]:

Jack Kain and we'll see you next time on the Results Are in by Quest Diagnostics. This podcast was produced in partnership with Amaze Media Labs.